People's Republic of China health system review

Overview

The People’s Republic of China has made great achievements in improving health status over the past six decades, mainly due to the government’s commitment to health, provision of cost-effective public health programmes, growing coverage of health financial protection mechanisms and investments in an extensive healthcare delivery network.

The demographic and epidemiological patterns have transitioned from high birth rate, high death rate, and infectious diseases to low birth rate, low death rate, and chronic diseases. Chronic diseases contribute to 85% of the approximately 10.3 million deaths of all-cause each year, accounting for 70% of the total burden of disease in China.

Continuous government input in basic public health services has greatly improved accessibility to public health services. In recent years, China has increased government investments in health and established basic medical insurance to reduce out-of-pocket (OOP) health payments and to raise the accessibility and equity of health services. Earmarked government grants are also allocated for public health works carried out by public hospitals.

Social health insurance schemes, including the rural cooperative medical scheme and the urban resident-based health insurance scheme that are mainly financed by government subsidies, and the urban employer-based health insurance scheme financed with contributions from both the employees and the employers have reached universal population coverage. These schemes cover both outpatient and inpatient care and have greatly increased accessibility to health services and improved financial risk protection. Over the past decade, OOP payments as a proportion of total health expenditures have declined dramatically, from 59% in 2000 to 34.4% in 2012.

However, despite the overall improvement, inequity in health and health care still exists, with gaps between urban and rural areas, between regions of different economic development levels, and between different groups of people, in terms of health care utilization, prenatal care, and catastrophic health expenditure. Consolidating the social health insurance schemes, integrating health providers, reforming the public hospital sector, adopting strategic purchasing mechanisms, and improving the quality of health care is the major current health system reforms in China.